Background— The objective of this study was to identify the impact of diabetes and related comorbidities, namely chronic renal failure, peripheral vascular disease, and low ejection fraction (<35%), on long-term survival of patients undergoing coronary artery bypass graft surgery. Methods and Results— A unicenter study was conducted on 9125 survivors of isolated coronary artery bypass graft surgery between 1992 and 2002. There were 6581 nondiabetic patients and 2544 diabetics, including 1809 patients with noninsulin-dependent diabetes mellitus and 735 patients with insulin-dependent diabetes mellitus. Cardiac-specific survival at 5 and 10 years was lower in insulin-dependent diabetes mellitus compared with both nondiabetic mellitus patients and patients with noninsulin-dependent diabetes mellitus ( P <0.0001). However, freedom from cardiac-related death was similar for patients with noninsulin-dependent diabetes mellitus and nondiabetes mellitus patients up to 6 years ( P =0 0.08) after surgery and was significantly lower thereafter ( P =0.004). Cardiac-specific survival after coronary artery bypass graft surgery in patients with one or more comorbidities was comparable ( P =0.4) for both nondiabetes mellitus patients and patients with noninsulin-dependent diabetes mellitus, but was significantly lower for those requiring insulin therapy ( P <0.0001). Noninsulin-dependent diabetes mellitus was not an independent predictor of long-term cardiac death (hazard ratio: 1.09, P =0.41); however, insulin-dependent diabetes mellitus, chronic renal failure, peripheral vascular disease, and low ejection fraction were all independent risk factors for late cardiac death (all P <0.0001). The impact of comorbidities on the long-term risk of cardiac death was similar for the 3 groups. Conclusions— Noninsulin-dependent diabetes is not an independent predictor of late cardiac death after coronary artery bypass graft surgery, because cardiac-related survival is similar to that of nondiabetic patients for 6 years after surgery. In diabetic and nondiabetic patients, cardiac survival is adversely affected by the need for insulin therapy and/or the presence and number of comorbidities such as chronic renal failure, peripheral vascular disease, and low ejection fraction.

Pacemaker contact sensitivity is a rare condition. Less than 25 reports of pacemaker skin reaction have been described over the past 30 years. This report describes one patient who developed contact dermatitis after implantation of two subsequent pacemakers. The diagnosis was made with skin patch tests that were positive to polyurethane 75D and polysulfone beige, two of the pacemaker and connector components. Review of the literature and general guidelines for the management of this unusual condition is depicted in this report.

Although occurrence of CVA seems mainly related to preoperative comorbidities, perioperative surgical variables, such as off-pump surgery, myocardial ischemia and cardiopulmonary bypass time, do not seem to independently influence CVA rate after CABG. In this regard CVA prevention should be performed before posing an indication to CABG, and closer evaluation of patients' risk profiles and tailored clinical/surgical strategies for those patients at higher risk for CVA occurrence should be included.

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